Sudden blindness following operative care of a multiply traumatized patient: posterior ischemic optic neuropathy

• Published in: Der Unfallchirurg 2006-08, Vol.109 (8), p.687-692
• Main Authors: Schmoz, S, Wawro, W, Weng, S, Stuttmann, R, Hofmann, G O
• Format: Article
• Language: ger
• Subjects: Adult; Blindness - diagnosis; Blindness - etiology; Bone Screws; Fracture Fixation, Internal - instrumentation; Fractures, Compression - diagnosis; Fractures, Compression - surgery; Hallucinations - diagnosis; Hallucinations - etiology; Humans; Male; Multiple Trauma - diagnosis; Multiple Trauma - surgery; Optic Atrophy - diagnosis; Optic Atrophy - etiology; Optic Neuropathy, Ischemic - diagnosis; Optic Neuropathy, Ischemic - etiology; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - surgery; Reoperation; Risk Factors; Spinal Fractures - diagnosis; Spinal Fractures - surgery; Spinal Fusion - instrumentation; Thoracic Vertebrae - injuries; Thoracic Vertebrae - surgery; Tomography, X-Ray Computed
• ISSN: 0177-5537
• DOI: 10.1007/s00113-006-1095-4

A 32-year-old man had fallen from an 8-m high scaffolding and had suffered multiple traumatic injuries, such as compression fractures of the thoracic vertebrae (TV) 5-7 without incarceration of the spinal canal plus a distal femoral fracture. During surgery on the day of the accident, spondylodesis and dorsal stabilization of TV 4-7 using an internal fixator were carried out and the distal femoral fracture was stabilized with a dynamic condylar screw (DCS). On the day following the accident, the malposition of a pedicle screw located at the height of TV 4 and the borderline malposition of a pedicle screw of TV 7 were corrected. Between the day of the accident and day 8 after, the patient developed impaired vision and in the further course amaurosis associated with fixed pupils. No organopathy could be noticed which could have explained the sudden vision loss. A study of the literature was done, using the keywords "blindness" and "spine surgery." Only very few cases describing a connection of spine surgery and postoperative vision loss could be found. This article aims to elaborate on the few connections worked out in these investigations.